Poison information center
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Establishment and development of Poison information center
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Poison information center
- 2. HISTORY In 1930’s – Louis Gdalman established the framework for the first poison control center at Ruspresbyterian-St.Luke’s hospital. In 1950’s – Missouri pharmacist, Homer George lead a poison prevention campaign in his hometown that eventually grew into a National poison prevention week
- 3. In 1980’s – Dr. Joseph Veltri chaired a committee to improve poison center data collection. This project grew into the Toxic Exposure Surveillance System(TESS) the largest poisoning database in the world. In addition pharmacists provide a key leadership roles in: American Association of Poison Control Centers American Academy of Clinical Toxicology The National Poison Prevention Week Council American Board of Applied Toxicology
- 4. Poison centers were established for two reasons: To provide rapid access to information valuable in assessing and treating poisonings To assist with poison prevention. GOALS: To provide comprehensive, accurate and timely information to their clients To enhance the medical care of patients Drug Information Center also exist with same goals as Poison Information center
- 5. DIFFERENCES BETWEEN DIC & PIC Drug Information Center Poison Information Center CLIENTELE 88% poison center calls are placed by public CALL VOLUME 103 calls per day, it ranges from 33 to 213 calls per day.depending upon service population size,poison center awareness in that area,poisoning rates. 9-10% calls are placed by public,but mostly by health care professionals. Fewer than 7 calls per day
- 6. HOURS OF OPERATION/COST Operates 24hrs a day year round More expensive STAFFING They use a wider variety of health care professionals FUNDING Public funding Operates 9AM-5PM Less expensive They rely on pharmacists Sponsored by hospitals or medical centers
- 7. RESPONSE TIME 15-30min or it may extend to days. Average response time is 5min. CALL COMPLEXITY Less complex REFERENCES Broader based reference collection DOCUMENTATION Less than PIC Standardized data collection instrument is present Not present More complex
- 8. The data elements that are currently being tracked through the TESS include: General epidemiological data- date and time of call, reason for exposure Caller characteristics- site of caller, city and state Patient characteristics- age and sex, pregnancy status Exposure characteristics- substance, route of exposure, site of exposure Clinical course- clinical manifestations and therapeutic interventions
- 9. HOW TO ORGANIZE A POISON CENTER Poison center expenses and potential revenues are directly tied to call volume. Therefore one of the most important considerations in organizing a poison center should be the “ideal human exposure call volume”. Maximal personnel, facility, and reference expenses can be predicted. PERSONNEL 1. Medical Director 2. Poison information specialists 3. Manager or Supervisor
- 10. 1. MEDICAL DIRECTOR: Ultimately responsible for all medical aspects of the poison center’s operation. The non physician poison information specialists provide medical care under the direction and authority of the program’s medical director. DUTIES Regular review and authorization of all poisoning management protocols. Authorization of poison center policies and procedures Participation in staff training Provision of on-call clinical support for poison center staff Participation in quality assurance activities Liaision with local medical societies, physicians, EMS, state and federal agencies
- 11. Promotion of research Coordination of professional education efforts Most poison center medical directors are board certified in internal medicine, pediatrics, or family practice. One indicator of expertise in medical toxicology might be board of certification through the Medical Toxicology Subspeciality Examination offered jointly by the American Board Of Pediatrics, American Board Of Emergency Medicine and American Board Of Medical Toxicology. According to AAPCC criteria for certification as a Regional Poison Center, the medical director should devote 50% of his or her professional activities to toxicology and spend atleast 10hrs per week working on poison center related activities. If the medical director is performing the duties outlined previously, it is likely that his or her time commitment will be met.
- 12. 2. POISON INFORMATION SPECIALISTS They directly interact with the public and health care professionals. Poison information specialists must be both clinicians and counselors. They must elicit a complete history, correctly assess the potential severity of exposure using the most appropriate management plan to the caller. In addition, poison information specialists must be able to focus callers who are unable to give cohesive history. Specialists should be able to communicate in a calm , reassuring manner at all levels of education. Both nurses and pharmacists are suitable poison information specialists. A national certification examination for specialists in poison information is offered each may through the American Association Of Poison Control Centers.
- 13. To take the examination , specialists must provide evidence that they have handled 2000 poison exposure cases and have worked 2000 hrs in poison center. In addition, they must have the approval of their center’s medical directors Certification is maintained by continuing to work atleast 8 annualized hours per week in poison center and passing the certification exam at atleast every 7 years. The American Association Of Poison Control Centers mandates that specialist must work a minimum annualized average of 16hrs per week. This drops to 8 hours a week once they have been certified.
- 14. Many centers tend to use part-time specialists working an average of 20 hours per week. On-call responsibilities may be integrated into the schedule so that unexpected coverage is handled fairly and efficiently. The on-call person may be paid a minimum hourly base rate. If he or she is called into the work, the person is paid one and onehalf times the regular rate of pay.
- 15. 3. MANAGER/SUPERVISOR The manager is responsible for administrative aspects of the center’s operation. Ideally this person has established clinical, administrative and supervisory skills DUTIES Budgeting Purchasing Staff scheduling, supervision, training Maintenance of continuous quality improvement program Development of department policies and procedures Preparation of administrative reports Media response Professional education
- 16. The manager/supervisor should know all aspects of the poison center’s program and have a complete knowledge base in clinical toxicology. The manager should be able to assist specialists during the assessment of difficult cases and substitute for specialists when the need arises. Many programs use pharmacists with postdoctoral training in clinical toxicology to fill this position, however, experienced nurses and physicians work equally as well. Certification through the American Board of Applied Toxicology or in the case of physicians, through the Medical Toxicology Subspeciality Examination provides evidence of an ongoing interest and expertise in clinical toxicology.
- 17. PUBLIC EDUCATION COORDINATOR Ideally this coordinator has a background in education and media communications and experience as poison information specialist The duties of public education coordinator may include: Development, distribution and evaluation of poison prevention programs and materials Coordination of regularly occuring public education messages through the media. Networking with schools and other organizations to provide costeffective public education. Coordination of poison prevention through poison information specialists.
- 18. OTHER PERSONNEL Secretarial support Volunteers Toxicology professionals Advisory boards IDEAL LOCATIONS Emergency department Next to a large medical library Hospital pharmacies Schools of pharmacy DIC
- 19. The work area should be designed to allow 100-200 square feet per work station and should be situated in a relatively quiet situation. Some poison centers prefer to separate work stations into walled cubicles to further eliminate peripheral distractions. Because stress is the primary draw back to working in a poison center, the work area should be designed to reduce stress as much as possible. Windows and natural lightning, ergonomic furniture, aquariums and soothing colors are starting points. The poison center medical director’s and manager’s offices should be adjacent to the main work area rather than in a different part of the facility,so,these individuals can provide constant support Portable telephones, call-answering devices and call forwarding to a cellular telephones are less expensive alternatives that provide varying degrees of functionality.
- 20. EQUIPMENT Telephone Personal computers Modem Facsimile machine Refrigerator and microwave File cabinets and shelving Generator
- 21. RESOURCES Micromedex’s poisindex(a database of more than 8,00,000 household products, chemicals, and medications) General product formulations are found in Clinical Toxicology Of Commercial Products by Gosselin, Smith, and Hodge. In addition they often maintain manufacture files with recent product formulations Information required stems from a specialized branch of toxicology Internal protocols, journals, medical literatures
- 22. POLICIES AND PROCEDURES It frames the poison center’s methods of operation. It clarifies the direction of the program and relates each operational facet and each other’s position in the poison center to the main operational directives At a minimum, each policy and procedure should be dated and signed by the medical director indicating that they have been reviewed and approved by this individual. In some settings there may be additional approvals required It is useful to maintain system for tracking policies and procedures so that when questions arise there is a simple way to determine operational policies existing at any given moment. Database management programs simplify much of this record keeping and reduce record storage requirements.
- 23. TRAINING OF SPECIALISTS The goals of training are to establish a comfortable telephone risk assessment routine, while gradually building the specialist’s knowledge base in clinical toxicology and fine-tuning telephone communication skills. Most poison centers spend between 6 and 8 weeks training specialists. The format varies depending on the center’s call volume, the staff’s experience, and allocation of resources by the sponsoring institution.
- 24. Basic training elements should include a discussion of: Policies and procedures Data collection format Reference use General poisoning management strategies Telephone communication technique Assessment and treatment of common deadly poisonings
- 25. THE FUTURE OF POISON CONTROL The poison information system is rapidly changing. Since its inception 40yrs ago, pharmacy has provided unique leadership and expertise. As long as medications top the list of substances responsible for poisoning, pharmacy will always be an integral part of the poison information system.
- 26. REFERENCE Drug information-A guide for pharmacists by Patrick M.Malone.
Notas do Editor
- Animated floating petals(Difficult)Tip: For best results with the animation effects on this slide, choose a picture with an object that is made up of multiple parts, like the flower in this example. To reproduce the background effects on this slide, do the following:On the Home tab, in the Slides group, click Layout, and then click Blank. Right-click the slide and then click FormatBackground.In the Format Background dialog box, click Fill in the left pane. In the Fill pane, select Picture or texture fill, and then under Insert from, click File. In the Insert Picture dialog box, select a picture, and then click Insert.On the Insert tab, in the Illustrations group, click Shapes, and then under Rectangles, click Rectangle (first option from the left). On the slide, drag to draw a rectangle. Select the rectangle. Under Drawing Tools, on the Format tab, in the Size group, do the following:In the Shape Height box, enter 7.5”.In the Shape Width box, enter 10”.On the Home tab, in the Drawing group, click the arrow next to Shape Outline, and then click No Outline.On the Home tab, in the Drawing group, click the arrow next to Shape Fill, point to Gradient, and then click More Gradients. In the Format Shape dialog box, click Fill in the left pane. In the Fill pane, select Gradient fill, and then do the following:In the Type list, select Radial.Click the button next to Direction, and then click From Center (third option from the left).Under Gradient stops, click Add gradient stops or Remove gradient stops until two stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops that you added as follows:Select the first stop in the slider, and then do the following:In the Position box, enter 0%.Click the button next to Color, and then under Theme Colors click Black, Text 1, Lighter 5% (sixth row, second option from the left).In the Transparency box, enter 40%.Select the last stop in the slider, and then do the following: In the Position box, enter 100%.Click the button next to Color, and then under Theme Colors click Black, Text 1, Lighter 5%(sixth row, second option from the left).In the Transparency box, enter 10%.Select the rectangle. On the Home tab, in the Drawing group, click Arrange, point to Align, and then do the following:Click Align Middle.Click Align Center. To reproduce the shape effects on this slide, do the following:On the Insert tab, in the Illustrations group, click Shapes, and then under Lines, click Freeform (11th option from the left).On the slide, click points to trace an outline around a shape on the background picture (in the example above, one of the flower petals). Right-click the freeform shape and click Edit Points. To make the freeform shape more similar to the shape on the picture, right-click a place to include another point, and click AddPoints. Drag the new point to follow the contour of the shape on the picture. To outline rounded edges of the shape on the picture, right-click a straight line segment, and click Curved Segment.Select the freeform shape. On the Home tab, in the bottom right corner of the Drawing group, click the Format Shape dialog box launcher. In the Format Shape dialog box, click Line Color in the left pane, and then in the Line Color pane, select No line. Also in the Format Shape dialog box, click Fill in the left pane, and then in the Fill pane, select Slide background fill. Repeat the process in steps 1-5to create six full-color shapes on the slide (in the example above, six flower petals from the same flower). To reproduce the animation effects on this slide, do the following:On the slide, select the rectangle. On the Animations tab, in the Advanced Animation group, click Add Animation, and then under Entrance click Fade.Also on theAnimations tab, in the Timing group, do the following:In theStartlist, select After Previous.In the Duration box, enter 2.00 seconds.On the slide, select one of the freeform shapes. On the Animations tab, in the Advanced Animation group, click Add Animation, and then under Emphasis click Spin.Also on the Animations tab, in the Timing group, do the following:In the Start list, select With Previous. In the Duration box, enter 2.00 seconds. On the Animations tab, in the Advanced Animation group, click Add Animation, and then under Emphasis click Grow/Shrink.Also on the Animations tab, in the Timing group, do the following:In the Start list, select With Previous. In the Duration box, enter 2.00 seconds. On the Animations tab, in the AdvancedAnimation group, click AddAnimation, and then click More Motion Paths. In the Add Motion Path dialog box, under Lines & Curves, click S Curve 1.Also on the Animations tab, in the Timing group, do the following:In the Start list, select With Previous. In the Duration box, enter 2.00 seconds. On the slide, select the S curve motion path. Point to the endpoint (red arrow) of the selected right motion path until the cursor becomes a two-headed arrow. Drag the endpoint off the right side of the slide.Right-click the motion path and select EditPoints, and then do the following:Right-click the middle point in the motion path animation and select SmoothPoint.Click the middle point. Drag one of the blue sizing lines until the curve in the motion path is smooth.On the slide, select the animated freeform shape. On the Animations tab, in the AdvancedAnimation group, click AnimationPainter, and then click one of the other freeform shapes. Repeat this process for each of the remaining freeform shapes.Also on the Animations tab, in the Advanced Animation group, click AnimationPane. In the Animation Pane, do the following to edit the animation effects:Select the second animation (first freeform shape spin effect). On the Animations tab, in the Animation group, click the EffectOptions dialog box launcher. In the Spin dialog box, do the following:On the Effect tab, in the Amount list, in the Custom box, enter 360⁰, and then press ENTER. Also in the Amount list, click Counterclockwise. On the Timing tab, in the Start list, select After Previous.Select the third animation (first freeform shape grow/shrink effect). On the Animations tab, in the Animation group, click the EffectOptions dialog box launcher. In the Grow/Shrink dialog box, do the following:On the Effect tab, in the Size list, in the Custom box, enter 40%, and then press ENTER. Also in the Size list, click Vertical. Select the fifth animation (second freeform shape spin effect). On the Animations tab, in the Animation group, click the EffectOptions dialog box launcher. In the Spin dialog box, do the following:On the Effect tab, in the Amount list, in the Custom box, enter 30⁰, and then press ENTER. Also in the Amount list, click Clockwise. On the Timing tab, in the Delay box, enter 0.1.Select the sixth animation (first freeform shape grow/shrink effect). On the Animations tab, in the Animation group, click the EffectOptions dialog box launcher. In the Grow/Shrink dialog box, do the following:On the Effect tab, in the Size list, in the Custom box, enter 40%, and then press ENTER. Also in the Size list, click Vertical. On the Timing tab, in the Delay box, enter 0.1.Select the seventh animation (first S-curve motion path effect). On the Animations tab, in the Timing group, in the Delay box, enter 0.1.Select the eighth animation (third freeform shape spin effect). On the Animations tab, in the Animation group, click the EffectOptions dialog box launcher. In the Spin dialog box, do the following:On the Effect tab, in the Amount list, in the Custom box, enter 40⁰, and then press ENTER. Also in the Amount list, click Clockwise. On the Timing tab, in the Delay box, enter 0.3.Select the ninth animation (third freeform shape grow/shrink effect). On the Animations tab, in the Animation group, click the EffectOptions dialog box launcher. In the Grow/Shrink dialog box, do the following:On the Effect tab, in the Size list, in the Custom box, enter 50%,and then press ENTER. Also in the Size list, click Horizontal. On the Timing tab, in the Delay box, enter 0.3.Select the 10th animation (first S-curve motion path effect). On the Animations tab, in the Timing group, in the Delay box, enter 0.3.Select the 11th animation (fourth freeform shape spin effect). On the Animations tab, in the Animation group, click the EffectOptions dialog box launcher. In the Spin dialog box, do the following:On the Effect tab, in the Amount list, in the Custom box, enter 90⁰, and then press ENTER. Also in the Amount list, click Counterclockwise. On the Timing tab, in the Delay box, enter 0.4.Select the 12th animation (fourth freeform shape grow/shrink effect). On the Animations tab, in the Animation group, click the EffectOptions dialog box launcher. In the Grow/Shrink dialog box, do the following:On the Effect tab, in the Size list, in the Custom box, enter 40%,and then press ENTER. Also in the Size list, click Vertical. On the Timing tab, in the Delay box, enter 0.4.Select the 13th animation (first S-curve motion path effect). On the Animations tab, in the Timing group, in the Delay box, enter 0.4.Select the 14th animation (fifth freeform shape spin effect). On the Animations tab, in the Animation group, click the EffectOptions dialog box launcher. In the Spin dialog box, do the following:On the Effect tab, in the Amount list, in the Custom box, enter 90⁰, and then press ENTER. Also in the Amount list, click Clockwise. On the Timing tab, in the Delay box, enter 0.5.Select the 15th animation (fifth freeform shape grow/shrink effect). On the Animations tab, in the Animation group, click the EffectOptions dialog box launcher. In the Grow/Shrink dialog box, do the following:On the Effect tab, in the Size list, in the Custom box, enter 50%,and then press ENTER. Also in the Size list, click Horizontal.On the Timing tab, in the Delay box, enter 0.5.Select the 16th animation (first S-curve motion path effect). On the Animations tab, in the Timing group, in the Delay box, enter 0.5.Select the 17th animation (sixth freeform shape spin effect). On the Animations tab, in the Animation group, click the EffectOptions dialog box launcher. In the Spin dialog box, do the following:On the Effect tab, in the Amount list, in the Custom box, enter 360⁰, and then press ENTER. Also in the Amount list, click Clockwise. On the Timing tab, in the Delay box, enter 0.6.Select the 18th animation (sixth freeform shape grow/shrink effect). On the Animations tab, in the Animation group, click the EffectOptions dialog box launcher. In the Grow/Shrink dialog box, do the following:On the Effect tab, in the Size list, in the Custom box, enter 50%,and then press ENTER. Also in the Size list, click Horizontal.On the Timing tab, in the Delay box, enter 0.6.Select the 19th animation (first S-curve motion path effect). On the Animations tab, in the Timing group, in the Delay box, enter 0.6.